Personality and Personality Disorders

Can you rely on self assessments for personality disorders?

No

What is personality disorder?

Psychological disorder that negatively affects a person’s life (pervasive pattern of maladaptive behavior)

How many areas must be affected in a maladaptive way on a regular basis for personality disorder?

2 out of 4

What are the four areas assessed for personality disorder?

• Cognition

• Interpersonal relationships

• Impulse control

• Affect

How many clusters are there for personality disorder?

3

What type of cluster for personality disorder is disturbed perceptions and have odd or eccentric personality characteristics such as schizotypal, schizoid, and/or paranoid?

Cluster A

What type of cluster A is discomfort with and reduced capacity for close relationships and cognitive and perceptual distortions that are actually within a realm of possibility?

Schizotypal

What are characteristics associated with schizotypal?

• Odd beliefs, magical thinking

• Body image distortion

• Paranoid ideation, suspiciousness

• Odd behavior/appearance

• Persistent social anxiety

• Odd thought processing, speech

What type of cluster A is detachment from social relationships and restricted range of expression and emotion?

Schizoid

What characteristics make up schizoid?

• Lack of desire for close relationships

• Chooses solitary experiences

• Little interest in sexual experiences, employment, hobbies

• Appears indifferent to praise/disapproval

• Appears detached, flat affect

What type of cluster A is distrust and suspiciousness and believes motives of others are malicious?

Paranoid

What characteristics make up paranoid?

• Preoccupied with doubts of others loyalty

• Reluctant to confide for risk of it being used against them

• Reads hidden meaning in benign remarks

• Holds grudges

• Readily perceives attacks on his/her character and responds angirly

For patients with cluster 1 disorders,

A) Do you expect the patient to trust you?

B) Do you expect to challenge beliefs, restate reality as you see it?

C) Should you be simple and calm?

D) Should you acknowledge the information you are receiving?

A) No

B) No

C) Yes

D) Yes

What are cluster B disorders?

Inability to recognize or care about effect on others

Dramatic, emotional, or impulsive personality characteristics

For cluster B, what are the dramatic, emotional, or impulsive personality characteristics?

• Histrionic

• Narcissistic

• Borderline

• Antisocial

What type of cluster B personality disorder is excessive emotionality and attention seeking behavior such as:

• Unhappy unless they are the center of attention

• Often sexually inappropriate or seductive in dress or behavior

• Displays rapidly shifting and shallow expression of emotions

• Consistently uses physical appearance to draw attention to self

• Has a dramatic style of speech that is excessively based on personal impressions and not on fact

• Dramatic emotional laden behavior

• Susceptible to influence of others

Histrionic Personality Disorder

What type of cluster B personality disorder is displaying grandiosity, need for admiration and lack of empathy in a variety of contexts such as:

• Grandiose sense of self-importance, exaggerates achievement and talents, and expects to be recognized as superior

• Preoccupied with fantasies of unlimited success, power, brilliance, beauty or being loved and adored

• Believes that he/she is “special” and can only be adequately understood or appreciated by other high status people

• Requires excessive admiration

• Extreme sense of entitlement – expects and deserves to be treated differently than others are treated

• Exploitative in interpersonal relationships

• Unwilling to recognize or identify with the feelings or needs or others

• Often envious of others or thinks others are envious of him/her

• Demonstrates arrogant behaviors and attitudes

Narcissistic Personality Disorder

What cluster B personality disorder is disregarding for and violation of the rights of others such as:

• Failure to obey laws that are meant to protect others

• Deceitfulness, lying, conning for personal gain

• Impulsivity and failure to consider consequences

• Irritability and physical aggressiveness

• Reckless disregard for the safety of others

• Consistent personal irresponsibility related to work and financial obligations

Antisocial Personality Disorder

What are your considerations when working with a patient with cluster 2(B) disorders?

• Focus on how intervention will be of benefit

• Minimize issue of consequences of not participating or complying

• Reinforce positive behaviors and their positive effects on the person

• Ignore provocative statements or state clearly that you won’t respond if provoked

• Do not become personally involved - lending money, socially, emotionally, ect…

What are 5 things NOT to say to someone with borderline personality disorder?

• Other people have it worse

• You need to grow up. Stop acting like a child

• You’re too sensitive/over dramatic/ you exaggerate

• Stop playing the victim/ take more responsibility for yourself

• Self harm is disgusting / stupid / attention seeking

What is a Cluster C personality disorder?

Difficulty in developing healthy / positive relationships with others. Anxious, uptight, or avoidant personality traits

What are the types of cluster C personality disorders?

• Obsessive - Compulsive PD

• Avoidant PD

• Dependent PD

What type of cluster C personality disorder is preoccupation with orderliness, perfectionism, and mental and interpersonal conduct such as:

• Details, rules, lists, organization, schedules – lose the overall purpose of activity

• Perfectionism interferes with task completion

• Excessive devotion to work to the exclusion of leisure activity and relationships

• Overly conscientious, scrupulous, inflexible about morality, ethics, values that are not consistent with cultural or religious identity

• Unable to discard worthless objects – not because of sentimental value

• Reluctant or refuses to delegate tasks

• Money may be hoarded against future catastrophes

• Rigidity and stubbornness

Obsessive-Compulsive PD

What type of cluster C personality disorder is social inhibition, feelings or inadequacy, and hypersensitivity to negative evaluation by others indicated by:

• Avoids occupational activities that involve significant interpersonal contact, due to fears of criticism, disapproval or rejection

• Unwillingness to get involved with people due to fear of not being liked (“ if only “fantasy)

• Shows restraint about intimate relationships due to fear of being ridiculed

• Unusually unwilling to take personal risks or try new activities due to fear of embarrassment

• Preoccupied with being criticized or rejected in social situations

• View self as socially inept, personally unappealing or inferior to others

Avoidant PD

What Cluster C personality disorder is excessive need to be taken care of - leads to submissive / clinging behavior, fear of separation as indicated by:

• Difficulty making everyday decisions without excessive advice and reassurance

• Needs others to assume responsibility for most parts of his/her life

• Difficulty in expressing disagreement with others because of fear of loss of support or approval

• Difficulty initiating projects or doing things on his/her own due to fear that they will fail, lack of self-confidence

• Going to excessive lengths to get nurturing and support

• Feeling helpless and uncomfortable being alone

• Urgently seeks another relationship when one ends

• Preoccupation with being left to take care of himself/herself

Dependent PD

What should you consider working with Cluster 3 (C) patients?

• Protect yourself from emotional burnout

• Not useful to try and build self-esteem but avoid creating plans that may result in failure or inability to carry out tasks

• Plan on short-term interaction, any session may be the last

• Keep communication to the point